0.5 to 3.7% of women have anorexia nervosa at some point in their lives. And while it is typically thought of as a disease for younger women and teens, individuals can be any age or sex and suffer from anorexia.
Anorexia nervosa can turn deadly if not treated or not treated adequately, so it is important that you or your loved one get help to recover. In this article, we’ll discuss what to expect in anorexia nervosa treatment so that it feels less daunting when you begin.
Read on to learn what exactly to expect.
You’ll Receive Therapy for Anorexia Nervosa
Individual psychotherapy is the cornerstone of anorexia nervosa treatment. While therapists may vary in the way they approach therapy, an experienced eating disorder clinician has substantial understanding of the medical, emotional, socio-cultural, environmental, and spiritual issues that play a part in the development and maintenance of this insidious disorder. While there are many well-trained clinicians in our communities, there are not many who actually are trained in treating eating disorders. It is important to find a person who can explain to you their experience in working with eating disorders. Such experience might include working previously at a residential treatment center, going for post-graduate training in eating disorders, or doing graduate research in the field of eating disorders.
The first thing that will happen in the office of a mental health professional is that they will conduct a clinical interview where you will provide the history of your eating disorder symptoms along with any other pertinent information about your emotional or physical health. The clinician will likely ask you detailed questions about your behavior, which can be a bit uncomfortable, but it is important to remember that keeping these symptoms secret will only make it worse in the long run. Typically, the evaluation period in psychotherapy is about 4-6 weeks. During that time, you and your therapist will get to know one another and you may also begin to address other psychological issues that are a part of the eating disorder, such as depression or anxiety.
As time goes by, you’ll also discuss body image disturbance, how you can combat negative thinking, ways to change unhealthy behaviors, crucial concerns to address for eating disorder sufferers. There may be additional treatment for other issues such as trauma, family communication, learning struggles, OCD, mood disorders, and life stressors, that must be properly addressed in order for the client to stay in recovery.
In the treatment of eating disorders, it is usually the individual therapist who coordinates the care for the client and is considered the “Captain of the Ship.” This allows for greater continuity of care for the client and it is crucial to your recovery that all members of your outpatient team speak to one another on a regular basis.
Levels of Care in Anorexia Nervosa Treatment
If your anorexia is severe enough, you may be referred to a higher level of care. When considering going to a treatment center, it is important to understand that there are different levels of care, depending on the severity of the symptoms.
- Inpatient: The highest and most comprehensive level of care for anorexia nervosa treatment. This is a hospital setting or a treatment center that is also licensed as a hospital. They can see the most acute patients who are at extremely low body weights. They also have the highest level of medical support and therefore can administer IV’s and tube feeding when necessary. Intensive therapy and nutritional therapy is also provided on a daily basis.
- Residential: This is a step down from inpatient and anorexia nervosa treatment is generally provided in a residential treatment center. While residential centers can also see patients who are very low weight and medically compromised, they have some limitations to what they can properly treat. Clients stay at the facility and receive round the clock care. These centers provide medical and nursing care along with significant therapeutic services and monitoring.
- Partial Hospitalization (PHP): Clients do not sleep at the treatment center though they spend 6-8 hours per day at the center receiving therapeutic services. Clients at this level of care are medically stable and have some ability to manage their symptoms on their own, without full time supervision or support.
- Intensive Outpatient (IOP): As in PHP, clients at this level of care must be medically stable and demonstrate fair to good motivation for recovery. Clients typically spend about 3 hours a day at the treatment center and are beginning to reintegrate back into their lives. IOP is most helpful when someone has successfully completed higher levels of care and still benefits from some additional structure and accountability. When someone is getting treatment for the first time and struggling to manage their symptoms on a daily basis, generally it is not helpful to start at the IOP level of care because it does not provide enough support throughout the day.
- Outpatient: This level of anorexia nervosa treatment is appropriate for clients who are medically stable, mostly weight restored, and who are willing manage their eating disorder symptoms by talking about them. Clients are this level of care are mostly or completely weight restored and show an ability to feed themselves consistently and appropriately. The only exception to this rule is clients who elect to do Family-Based Therapy (FBT).
If you do not currently have a psychologist who you have seen in an outpatient setting and you are concerned about your anorexia nervosa, it is often helpful to make an appointment with a psychologist first who can do an evaluation and discuss your treatment options with you. In addition, an experienced eating disorders clinician will have familiarity with treatment centers and may guide you to certain centers based on your personal situation. Additionally, that psychologist will then be prepared to work with you once you complete your treatment at a center and you will already know each other before you start up therapy again.
When you go to a treatment center, regardless of level of care, you will receive individual and group therapy, in addition to a variety of other services. This allows you to work intensively on yourself and to meet others who have similar struggles. Knowing that you are not alone in your struggles can be extremely validating and relieving to those who have felt so alone in their disorder.
If you or a your loved one has recently admitted that you have anorexia, it is important that you also seek a medical evaluation immediately. There are some very serious medical conditions that can deteriorate quickly if not diagnosed quickly. In some cases, doctors will admit you to the hospital to stabilize your symptoms and begin the refeeding process. While this is a very difficult experience, it can mean the difference between life and death. It is also important to follow up a hospitalization with the appropriate level of care afterward and not assume that you are ready to go back to life as normal. This is a very common mistake made by families new to dealing with eating disorders. If your eating disorder is severe enough to affect your health, we must honor what your body is telling you and make the time and space for you to adequately recover before returning to your normal activities and commitments.
Many therapists work closely with qualified eating disorder nutritionists when it comes to eating disorder treatment. You’ll likely also work with a nutritionist to help challenge your thinking about food. While this is incredibly difficult, it is very important, as creating a normal, healthy relationship with food is central to your recovery.
You may be challenged to eat food out of your comfort zone and to eat food that your eating disorder has decided is unacceptable. Usually, a nutritionist will work with both you and your therapist to create a meal plan for you. This will be something that you and your nutritionist agree on and is vital for your recovery. Most clients find that having a meal plan takes the guesswork out of it and allows them to go against the food rules dictated by their eating disorder. A meal plan is a tool to get you started in your recovery and not something you will need to use forever. If you are receiving some or all of your meals in the context of a treatment center, you will be expected to eat 100% of what is served to you. The treatment center will identify your body’s caloric needs on a weekly basis and make adjustments to your meal plan. If you are working with an outpatient nutritionist, the same holds true, you will still need to eat 100% of your meal plan but you will be responsible for preparing and portioning your own meals. Many individuals in the beginning phases of recovery need some support from family or friends to make sure they are adhering to the meal plans because the anorexia can make it difficult to do this.
Recovering from Anorexia Nervosa
Do you find yourself relating to the symptoms of anorexia nervosa? Anorexia nervosa treatment can be a process that is difficult to handle all on your own. Thankfully, you don’t have to. You can recover at any time from anorexia nervosa, don’t wait until your symptoms get worse.
I’m Dr. Amy Boyers, a Clinical Psychologist in Miami who specializes in the treatment of eating disorders (all types) and other serious, long-term mental health conditions, including addictions, bipolar disorder, and OCD. I offer personalized and sophisticated eating disorder treatment services, individual and family psychotherapy, family member support and education, in-home meal support, coordination of a treatment service, and much more.
Have any questions about the eating disorder recovery process? I’d be happy to answer them. Simply reach out to me and I’ll be sure to answer anything you want to know.
I look forward to helping you obtain a brighter tomorrow.
Want to learn more about other eating disorders? Read our full guide to the different types of eating disorders.